Attention Deficit/Hyperactivity Disorder
Children with Duchenne are at increased risk for having an attention-deficit disorder. The formal name for this type of condition is Attention-Deficit/Hyperactivity Disorder (ADHD).
The following symptoms may indicate the presence of ADHD
Impulsivity
- Acts or says things without thinking
- Impatient or has difficulty waiting turn
- Interrupts/intrudes on others
- Talks excessively
- Acts too silly at inappropriate times
Hyperactivity
- Fidgets, can’t sit still
- Often leaves seat
- Difficulty playing quietly, overly wound up
Inattention
- Does not seem to listen
- Avoids doing things that require sustained mental effort
- Loses or misplaces important things
- Forgets to turn in work, even though it is completed
- Rushes through things, makes careless errors
- Doesn’t complete work or turns things in incomplete
- Easily distracted
There are several different types of ADHD
- Predominantly Hyperactive-Impulsive Type
- Predominantly Inattentive Type
- Combined Type
It is important to note that because of muscle weakness and physical limitations, symptoms of hyperactivity may be less obvious in children with Duchenne. Thus, impulsivity may be the most obvious feature of ADHD for these children. They may also have reduced sensory tolerances (see Sensory Processing Disorder).
All types of ADHD may include weaknesses in executive functioning. Thus, children with ADHD are more likely to have problems getting started on things, and have difficulty with planning, problem-solving, and time management.
It is important to know that some of the cognitive patterns observed in Duchenne can lead to a child being misidentified as having ADHD. More specifically, language or discrete short-term memory deficits may cause a child to appear inattentive or forgetful, or to have difficulty following directions. Mental healthcare providers should consider these alternative possibilities prior to giving a child with Duchenne a diagnosis of ADHD.
Ways to help
Treatment and intervention often includes the three components below:
Use medication
The use of medication is the most effective component for many children. Approximately 80 to 90% of children with ADHD obtain some benefit from medication, although this is not always complete improvement. Stimulants are the most commonly prescribed medications. Most children with Duchenne respond well to treatment with stimulant medication. However, stimulant medications should be used with extreme care in any child with heart problems which are common in older children with Duchenne. Thus, the doctor should closely monitor the cardiac status of people with Duchenne who are prescribed stimulant medications. Some people may have a minor increase in heart rate and blood pressure when taking these medications, even if they have not yet developed heart problems. It is unknown what potential impact this could have on their heart over the long run. There are non-stimulant medications that are also approved for treatment of ADHD that may be a good option for some people with Duchenne, but they may also increase heart rate in some children.
Psychosocial strategies
Another component of ADHD intervention consists of psychosocial strategies. Behavioral therapy is not very effective in changing the core features of hyperactivity, impulsivity, and inattention. However, it can be useful in improving compliance and reducing arguing and temper tantrums, which tend to be problematic for about 40% of kids with ADHD. Behavioral therapies are usually the most effective before the child is 10 or 11 years old, so early intervention is key.
Modifying or adapting environment
The third component of ADHD intervention usually involves modifying or adapting the child’s environment to reduce the impact that ADHD has on their daily activities. This includes things like increasing more structure and oversight during activities, implementing compensatory strategies at school or home, developing supports for memory and organizational weaknesses, and implementing routines that can be followed consistently.
Information in this section was contributed, in part, by James Poysky, PhD. Read Dr. Poysky’s entire document, Learning and Behavior in Duchenne (download).
